Radiology Coding Alert

Question: I’m debating between 36561 and 36563 for a procedure involving the insertion of a PowerPort^® implantable infusion catheter, centrally tunneled for a patient over 5 years old. Fluoroscopy and ultrasound guidance are included. The report is saved in a picture archiving and communication system (PACS).

Tennessee Subscriber

Answer: Since the surgeon documents the insertion of a port, not a pump, you’re going to report 36561 (Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older). However, you should also be reporting the appropriate codes for the use of fluoroscopic and ultrasound guidance.

Fluoroscopic guidance can be reported with +77001 (Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)).

For ultrasound guidance, you’ll look no further than +76937 (Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure)).

Keep in mind that +76937 is only eligible when a system such as a PACS is used to capture hard copy images. The radiology report must also specifically document the permanent recording of ultrasound imaging. There are no National Correct Coding Initiative (NCCI, or CCI) Procedure-to-Procedure (PTP) edits between +77001 and +76937, so these can be reported without any modifier considerations.